Background: Bone alterations have been observed in the course of HIV infection, characterized by a marked decrease in bone mineral density (BMD) and an increase in the frequency of fractures as a result of fragility. We aim to evaluate early changes in bone metabolic profile and the possible association with tenofovir and other nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) in treatment-naïve HIV patients.

Methods: We conducted a prospective study in naïve HIV-infected adults (under 50 years), separated into three groups according to NRTI therapy: tenofovir disoproxil fumarate (TDF); tenofovir alafenamide (TAF) and abacavir (ABC). BMD and epidemiological, immunological and metabolic bone parameters were evaluated. Bone markers were analyzed in plasma at baseline, 12 and 48 weeks after initiating treatment.

Results: Average age of patients was 34.8 years (± 9.6). 92.4% of them with CD4 count > 200 cel/μL. At week 12 after starting treatment, both TDF [increase in PN1P (31.7%, p = 0.004), TRAP (11.1%, p = 0.003), OPN (19.3%, p = 0.045) and OC (38.6%, p = 0.001); decrease in OPG (-23.4%, p = 0.003)] and TAF [increase in 42.6% for CTX (p = 0.011), 27.3% for OC (p = 0.001) and 21% for TRAP (p = 0.008); decrease in OPG (-28.8%, p = 0.049)] presented a deep resorption profile compared to ABC, these differences in bone molecular markers, a tendency to equalize at week 48, where no significant differences were observed. Patients treated with TDF showed the greatest decrease in Z-score in both lumbar spine (LS) and femoral neck (FN) at week 48 without statistically significant differences.

Conclusion: Treatment-naïve HIV patients have a high prevalence of low bone density. Treatment with TDF is associated with greater bone deterioration at 12 and 48 weeks. TAF seems to present similar early bone deterioration at 12 weeks which disappears at 48 weeks.

背景：在 HIV 感染过程中观察到骨骼改变，其特征是骨矿物质密度 (BMD) 显着降低，并且由于脆性而导致骨折频率增加。我们旨在评估未接受过治疗的 HIV 患者骨代谢特征的早期变化以及与替诺福韦和其他核苷和核苷酸逆转录酶抑制剂 (NRTIs) 的可能关联。

方法：我们对未感染 HIV 的成人（50 岁以下）进行了一项前瞻性研究，根据 NRTI 治疗分为三组：富马酸替诺福韦酯 (TDF)；替诺福韦艾拉酚胺 (TAF) 和阿巴卡韦 (ABC)。评估了 BMD 和流行病学、免疫学和代谢骨参数。在基线、开始治疗后 12 周和 48 周时分析血浆中的骨标志物。

结果：患者的平均年龄为 34.8 岁 (± 9.6)。其中 92.4% 的 CD4 计数 > 200 cel/μL。在开始治疗后第 12 周，TDF [PN1P (31.7%, p = 0.004)、TRAP (11.1%, p = 0.003)、OPN (19.3%, p = 0.045) 和 OC (38.6%, p = 0.001 ); OPG (-23.4%, p = 0.003)] 和 TAF [CTX 增加 42.6% (p = 0.011)，OC 增加 27.3% (p = 0.001) 和 TRAP 增加 21% (p = 0.008)；OPG 降低 (-28.8%, p = 0.049)] 与 ABC 相比呈现深度吸收曲线，这些骨分子标志物的差异，在第 48 周趋于平衡，没有观察到显着差异。接受 TDF 治疗的患者在第 48 周时腰椎 (LS) 和股骨颈 (FN) 的 Z 评分下降幅度最大，但无统计学差异。

结论：未接受过治疗的 HIV 患者骨密度低的患病率很高。TDF 治疗与 12 周和 48 周时更大的骨退化有关。TAF 似乎在 12 周出现类似的早期骨退化，在 48 周消失。